As we discuss the dementia that took Robin Williams away from us--and is now affecting Ted Turner--one can see the way that forms of dementia may be very difficult to differentiate for the diagnostician. In fact, Dementia with Lewy Bodies (DLB) or Lewy Body Dementia (LBD) exhibits characteristics of both Alzheimer's and Parkinson's Diseases, with LBD showing signs similar to Alzheimer's in the early stages and Parkinson's in later progression.
So...just what is a Lewy Body? Again, we look to protein deposits as the trademark of a form
of dementia. Lewy bodies, are abnormal deposits of an alpha-synuclein protein. It is known that their presence and the loss of connections among nerve cells are linked; however, their specific role in the disorder is not yet completely clear from a detailed scientific standpoint. Lewy bodies are also present in Parkinson's Disease--perhaps a reason that differential diagnosis is difficult and why LBD is often confused with Parkinson's.
To determine whether the patient has LBD or Parkinson's, one evaluates the symptoms in terms of two areas--timing and effects.
If cognitive decline occurs concurrently with mobility/motor symptoms, the diagnosis is likely Lewy Body Dementia. If mobility/motor skill changes manifested at least a year prior to the onset of cognitive decline symptoms, the diagnosis is likely Parkinson's Disease.
Parkinson's Disease has loss of motor function as a primary effect--including weakness, tremors, and rigidity--whereas Lewy Body Dementia is primarily cognitive decline with physical symptoms be additive.
It is estimated that only about 20% of people diagnosed with Parkinson's Disease eventually develop dementia.
Because of this overlapping of symptoms--with Parkinson's as well as other diseases--medical professionals suspect that Lewy Body Dementia is under-diagnosed. Based on data such as post-death brain studies, it is thought that Lewy Body Dementia actually accounts for about 10% of all dementia cases of dementia.
While there are similarities between Lewy Body Dementia (LBD) and other disease, there are signs that point specifically to LBD. These symptomatic pointers include:
Hallucinations, either visual or auditory, that tend to be very detailed in nature. It is estimated that about 75% of people suffering from LBD have recurring hallucinations, primarily visual.
Visual difficulties that resulting in misinterpreting what they see. An example is double vision.
A combination of visual decline and hallucinations results in the patient becoming delusional. This step--beyond simply having hallucinations--is when people start believing in things that are not true, such as others living in a house where they are actually alone, people being replaced by impostors, or being persecuted by someone or something that is not actually there.
Disruption of the REM sleep cycle, characterized by persistent vivid dreams, falling, voluntary (subconscious) and violent movements that appear to be acting out a nightmare, and increased likelihood of daytime sleeping because of lack of restful sleep at night.
As LBD progresses, these symptoms worsen, resulting in Alzheimer's-like cognitive decline combined with more pronounced behavioral changes. Now, it is easy to see how LBD, Parkinson's, and even Alzheimer's diagnoses are challenged by these symptom similarities.
What Can Be Done?
Lewy Body Dementia patients are typically hypersensitive to many pharmaceuticals; therefore, it is highly recommended that the primary course of action in treatment be non-pharmaceutical in nature. Some non-drug treatment regimens that have proven to be successful in mitigating or toning down symptoms of LBD include:
Therapy, such as speech and communication therapy and life skills therapy.
Cognitive exercises combined with psychotherapies to help with mitigating memory loss, confusion, and disorientation.
Caregiving options--not only to address daily task deficits, but also to manage care as the symptoms progress and the LBD patient is no longer able to care for themselves.
As mentioned above, LBD patient will eventually need extensive care. These therapeutic measures help to lessen the psychological burden for LBD patients; however, the average life expectancy of a person diagnosed with LBD is about 5-8 years, with the rate of progression being as individual as the patient themselves.
Lists in this article adapted from Earlstein, F. (2016). Dementia Facts & Information. NRB Publishing: Nevada.
For more resources and references on Lewy Body Dementia, see the following:
Lewy Body Dementia News & Research: https://www.drcarlforkner.com/dementia-memory-news